MEDICARE: HOME BOUND HEALTHCARE NEVADA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	29D1097507	NV
2	251E00000X	Home Health Agency	5607HHA-0	NV

General Provider Information

NPI Number	:	1326280439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME BOUND HEALTHCARE NEVADA, INC.

Provider Business Mailing Address
First Line	:	1350 S JONES BLVD
Second Line	:	SUITE 240
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1206
Country	:	US
Telephone Number	:	702-433-0800
Fax Number	:	702-433-0801

Provider Business Practice Location Address
First Line	:	1350 S JONES BLVD
Second Line	:	SUITE 240
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1206
Country	:	US
Telephone Number	:	702-433-0800
Fax Number	:	702-433-0801

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JEFFREY KALKOWSKI
Credential	:
Telephone Number	:	702-433-0800

Provider Enumeration Date	:	04/03/2009
Last Update Date	:	04/21/2010

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